IHSJ Reader, July 13, 2012

FOREIGN ASSISTANCE

Global Health Solidarity at a Crossroads(Agnes Binagwaho, Project Syndicate, July 5, 2012)Dr. Agnes Binagwaho, Rwanda’s minister of health, reflects on the impact of the Global Fund to Fight AIDS, Tuberculosis, and Malaria and calls on donor governments to increase lifesaving contributions to end the Global Fund’s funding problems. With support from the Global Fund and the President’s Emergency Plan for AIDS Relief (PEPFAR) over the past decade, Rwanda has remarkably improved the health of its citizens by providing comprehensive care—from universal access to antiretroviral therapy to integrated treatment for infectious disease, primary care, and noncommunicable diseases. To ensure Rwanda’s successes are sustainable and replicable, the world’s largest economies need to fulfill their pledges to the Global Fund. The Global Fund’s critical country-owned support has made it possible to improve the lives of the world’s poorest, but Binagwaho argues that failing to continue funding these advancements will be a standard by which history will measure our “capacity for justice.”

Obama Administration Closes Global Health Initiative Office(John Donnelly, Global Pulse, July 3, 2012)Only three years after President Obama launched the Global Health Initiative (GHI), the office is closing, and the work of GHI will now be incorporated into the State Department’s Office of Global Diplomacy. GHI Executive Director Lois Quam explained that the shift in focus toward diplomacy will “bring more resources to achieve GHI targets”; however, others are skeptical. Could one less global health program in Washington really mean that the Obama administration’s global health plan will get more rather than less attention?

Failure to Launch: A Post-Mortem of GHI 1.0(Amanda Glassman and Rachel Silverman, Center for Global Development, July 9, 2012)This article presents a critical assessment of the Obama administration’s decision to close the Global Health Initiative (GHI), which was established to encourage an integrated approach to global health. The authors argue that the GHI closure reflects a lack of political will to face the issues of integration and transparency. The numerous disconnected initiatives launched by multiple U.S. agencies in health and development highlight the increasing need for the fully integrated and financed strategy the GHI had promised.

HEALTH EQUITY

The Legal Reasoning that Preserved ACA’s Individual Mandate(Lawrence Gostin, The JAMA Forum, July 2, 2012)Two weeks ago, the U.S. Supreme Court ruled in National Federation of Independent Business v. Sebelius that the Affordable Care Act (ACA) was constitutional under Congress’ power to tax. In advance of the ruling, the constitutionality of the ACA and its individual mandate had been based on congressional commerce power. Gostin discusses the negative impact of the Supreme Court’s rejection of the commerce power. While celebrating the ACA’s goal of universal access, he points out that the Supreme Court’s opinion focuses on protecting personal freedoms over the “greater” freedom of access to care and treatment in the event of an injury or illness.

The Crusade for Health Equity(British Medical Journal, June 27, 2012)The financial crisis in Europe has exacerbated the effects of poverty on many worldwide, including Europeans themselves, where countries such as Spain and Greece are experiencing health care cutbacks and widening disparities. The need for international movements promoting equitable health care is greater than ever. While the “Occupy” movement with its “99%” motto exposed the world to wealth disparities, another less publicized but continually growing movement directly targeting health disparities is on its way. The People’s Health Movement (PHM), a network of health professionals, NGOs, advocacy groups, and academics, produces reports that criticize the lack of structure in global governance of health and development, while demanding that rich countries provide more debt relief to countries with smaller economies and that low- and middle-income countries better protect their citizens’ health. PHM is currently holding its third global assembly in Cape Town and is calling for European policy makers to increase access to universal health care, much like Thailand, Brazil, and Vietnam have done.

Pillars for Progress on the Right to Health: Harnessing the Potential of Human Rights through a Framework Convention on Global Health(Eric Friedman, Lawrence Gostin, Health and Human Rights, June 2012)Despite the increasing presence of “the right to health” in conventions and constitutions around the world, for millions it remains a right that is far from being realized. The authors propose a four-step approach to expedite the fulfillment of the fundamental right to health. Implementing a global health agreement, a Framework Convention on Global Health (FCGH), could create each of these pillars and amplify the voice of communities suffering from health inequities. The momentum for a FCGH is being led by a civil society coalition, of which PIH is a member, and is aimed at promoting health equity.

NONCOMMUNICABLE DISEASES

Tracking Global Funding for the Prevention and Control of Noncommunicable Diseases(Amitava Banjeree, WHO eBulletin, July 2012)This editorial explains why transparently tracking funding, delivery, and outcomes of global health programming is essential for effective global health funding. Improving tracking and reporting mechanisms is especially relevant as international attention shifts to treating noncommunicable diseases, which require the development of new metrics, targets, and methods of healthcare delivery. The editorial demonstrates the importance of PIH's approach of combined service, training, advocacy, and research, as effective research is needed to design the right interventions as well as advocate for ongoing funding and support.

RWANDA

Health Care Coverage that Eludes the U.S.(Tina Rosenberg, The New York Times, July 3, 2012)This opinion piece speaks to the astounding progress seen in Rwanda's health outcomes as the result of a revitalized public health system and a national insurance scheme grounded in a preferential option for the poor. Hospital utilization rates have tripled due to increased financial access to care, and maternal and childhood mortality dropped precipitously in the last 10 years. Rwanda, one of the world’s most impoverished nations, is perhaps the closest in Africa to achieving the U.N. Millennium Development Goals. Rwanda’s demonstrable commitment to the right to health of its people is a standard to which all countries, rich and poor, should be held.

TUBERCULOSIS

CDC Grand Rounds: The TB/HIV Syndemic(Centers for Disease Control and Prevention, Morbidity and Mortality Weekly Report, July 6, 2012)This issue focuses on combatting the global syndemic of tuberculosis (TB) and HIV. Though TB causes more than 1.5 million deaths each year, diagnosis and treatment of the disease haven’t advanced for decades. Communities in low-resource areas face high rates of HIV and TB co-infection because the relatively archaic TB diagnostics are even less effective for people living with HIV. In response to this dual burden and recent research, the authors ask international leaders to call for improvements in TB screening, diagnosis, and treatment, particularly in settings with high prevalence of HIV/AIDS.

MULTIMEDIA/ADDITIONAL RESOURCES

Is an AIDS-Free Generation within Reach?(All Things Considered, National Public Radio, July 3, 2012)Ambassador Eric Goosby, U.S. global AIDS coordinator for the President’s Emergency Plan for AIDS Relief (PEPFAR), reports on PEPFAR’s progress and the program’s challenges and successes with increasing access to antiretroviral therapy for HIV/AIDS patients in Haiti and sub-Saharan Africa. In Haiti, PEPFAR has reduced the costs of successfully treating an HIV/AIDS patient by more than two-thirds in less than a decade, and nearly 4 million people are now on PEPFAR-funded treatment worldwide. In the U.S., however, treatment remains expensive, ranging from $7,000 to $9,000 per year. Despite this gap and the difficulties of identifying HIV/AIDS patients early in resource-poor settings, Goosby is confident the U.S. will meet all the World AIDS Day goals with its current budget, thus edging the global community toward the AIDS-free generation called for by President Obama.

Universal Coverage: Can We Guarantee Health for All?(British Medical Center Public Health Supplement, June 2012)This issue focuses on universal health care coverage. At a pertinent time in the U.S. and global political sphere, this supplement is a great resource for recent research and thematic reviews of attaining universal access to health care from a variety of authors and institutions.